| NPI | 1346318532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DAVID DEGOULD Oral Surgeon Owner 815-654-0039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021001500) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2013-01-28 |